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Dying Patients and Palliative Sedation
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To the Editor: In their article on palliative sedation in dying patients, Drs Lo and Rubenfeld1 present the ethical foundation for the administration of palliative sedation for moribund patients. The authors extend their argument: "Palliative sedation might also be considered for patients who are terminally ill but not moribund, in cases involving the withdrawal of artificial nutrition and hydration, and in cases involving existential distress rather than physical symptoms." The reasoning that supports a role for palliative sedation in these clinical circumstances is not detailed, so the authors' opinions are more ethically problematic.
For example, the authors state that "the ethical rationale for palliative sedation. . . holds equally for patients with refractory symptoms who are terminally ill as well as those who are moribund." They make an appropriate distinction between the conditions of "moribund" and "terminally ill," but dismiss the need to justify the use of palliative sedation and . . . [Full Text of this Article]
Ware Kuschner, MD
ware.kuschnermd@med.va.gov
Pulmonary Section
Veterans Affairs Palo Alto Health Care System
Palo Alto, Calif
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